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Sherman EM, Agwu AL, Ambrosioni J, Behrens GMN, Chu C, Collins LF, Jimenez HR, Koren DE, McGorman L, Nguyen NN, Nicol MR, Pandit NS, Pierre N, Scarsi KK, Spinner GF, Tseng A, Young JD, Badowski ME. Consensus recommendations for use of long-acting antiretroviral medications in the treatment and prevention of HIV-1: Endorsed by the American Academy of HIV Medicine, American College of Clinical Pharmacy, Canadian HIV and Viral Hepatitis Pharmacists Network, European AIDS Clinical Society, and Society of Infectious Diseases Pharmacists. Pharmacotherapy 2024; 44:494-538. [PMID: 39005160 DOI: 10.1002/phar.2922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 07/16/2024]
Abstract
Five long-acting (LA) antiretrovirals (ARVs) are currently available in a limited number of countries worldwide for HIV-1 prevention or treatment-cabotegravir, rilpivirine, lenacapavir, ibalizumab, and dapivirine. Implementing use of LA ARVs into routine clinical practice requires significant changes to the current framework of HIV-1 prevention, treatment, and service provision. Given the novelty, complexity, and interdisciplinary requirements needed to safely and optimally utilize LA ARVs, consensus recommendations on the use of LA ARVs will assist clinicians in optimizing use of these agents. The purpose of these recommendations is to provide guidance for the clinical use of LA ARVs for HIV-1 treatment and prevention. In addition, future areas of research are also identified and discussed.
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Affiliation(s)
- Elizabeth M Sherman
- Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
- Division of Infectious Disease, Memorial Healthcare System, Hollywood, Florida, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Juan Ambrosioni
- HIV Unit and Infectious Disease Service, Hospital Clinic and Fundació de Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Georg M N Behrens
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Hannover, Germany
- Centre for Individualized Infection Medicine (CiiM), Hannover Medical School, Hannover, Germany
| | - Carolyn Chu
- University of California San Francisco, San Francisco, California, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Emory School of Medicine, Grady Ponce de Leon Center, Atlanta, Georgia, USA
| | - Humberto R Jimenez
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
- Comprehensive Care Center, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - David E Koren
- Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Leslie McGorman
- American Academy of HIV Medicine, Washington, District of Columbia, USA
| | - Nancy N Nguyen
- Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, California, USA
| | - Melanie R Nicol
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA
| | - Neha Sheth Pandit
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland, USA
| | - Natacha Pierre
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kimberly K Scarsi
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gary F Spinner
- Southwest Community Health Center, Bridgeport, Connecticut, USA
| | - Alice Tseng
- Immunodeficiency Clinic, University Health Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy D Young
- Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Melissa E Badowski
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
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2
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Kaggiah A, Maina CN, Kinuthia J, Barthold D, Hauber B, Tran J, Simoni JM, Graham SM. Key informant views on potential acceptability and feasibility of long-acting antiretroviral treatment for HIV in Kenya. BMC Infect Dis 2024; 24:415. [PMID: 38641565 PMCID: PMC11027348 DOI: 10.1186/s12879-024-09309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/09/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND In 2020, 14% of diagnosed persons living with HIV (PLWH) in Kenya were not taking antiretroviral therapy (ART), and 19% of those on ART had unsuppressed viral loads. Long-acting antiretroviral therapy (LA-ART) may increase viral suppression by promoting ART uptake and adherence. We conducted key informant (KI) interviews with HIV experts in Kenya to identify product and delivery attributes related to the acceptability and feasibility of providing LA-ART to PLWH in Kenya. METHODS Interviews were conducted via Zoom on potential LA-ART options including intra-muscular (IM) injections, subcutaneous (SC) injections, implants, and LA oral pills. KI were asked to discuss the products they were most and least excited about, as well as barriers and facilitators to LA-ART roll-out. In addition, they were asked about potential delivery locations for LA-ART products such as homes, pharmacies, and clinics. Interviews were recorded and transcribed, and data were analyzed using a combination of inductive and deductive coding. RESULTS Twelve KI (5 women, 7 men) participated between December 2021 and February 2022. Overall, participants reported that LA-ART would be acceptable and preferable to PLWH because of fatigue with daily oral pills. They viewed IM injections and LA oral pills as the most exciting options to ease pill burden and improve adherence. KI felt that populations who could benefit most were adolescents in boarding schools and stigmatized populations such as sex workers. SC injections and implants were less favored, as they would require new training initiatives for patients or healthcare workers on administration. In addition, SC injections would require refrigeration and needle disposal after use. Some KI thought patients, especially men, might worry that IM injections and implants would impact fertility, given their role in family planning. Pharmacies were perceived by most KI as suboptimal delivery locations; however, given ongoing work in Kenya to include pharmacies in antiretroviral delivery, they recommended asking patients their views. CONCLUSION There is interest and support for LA-ART in Kenya, especially IM injections and LA oral pills. Identifying patient preferences for modes and delivery locations and addressing misconceptions about specific products as they become available will be important before wide-scale implementation.
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Affiliation(s)
- Anne Kaggiah
- Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya.
| | - Catherine N Maina
- Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Douglas Barthold
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | - Brett Hauber
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
- Worldwide Medical and Safety, Pfizer, Inc, New York, NY, USA
| | - Jacinda Tran
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | - Jane M Simoni
- Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
| | - Susan M Graham
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Irvine MK, Zimba R, Avoundjian T, Peterson M, Emmert C, Kulkarni SG, Philbin MM, Kelvin EA, Nash D. Patient Education and Decision Support for Long-Acting Injectable HIV Antiretroviral Therapy: Protocol for Tool Development and Pilot Testing with Ryan White HIV/AIDS Program Medical Case Management Programs in New York. JMIR Res Protoc 2024; 13:e56892. [PMID: 38536227 PMCID: PMC11007615 DOI: 10.2196/56892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Long-acting injectable (LAI) HIV antiretroviral therapy (ART) presents a major opportunity to facilitate and sustain HIV viral suppression, thus improving health and survival among people living with HIV and reducing the risk of onward transmission. However, realizing the public health potential of LAI ART requires reaching patients who face barriers to daily oral ART adherence and thus can clinically benefit from alternative treatment modalities. Ryan White HIV/AIDS Program Part A medical case management (MCM) programs provide an array of services to address barriers to HIV care and treatment among economically and socially marginalized people living with HIV. These programs have demonstrated effectiveness in improving engagement along the continuum of care, but findings of limited program impact on durable viral suppression highlight the need to further innovate and hone strategies to support long-term ART adherence. OBJECTIVE This study aims to adapt and expand Ryan White MCM service strategies to integrate LAI ART regimen options, with the larger goal of improving health outcomes in the populations that could most benefit from alternatives to daily oral ART regimens. METHODS In 3 phases of work involving patient and provider participants, this study uses role-specific focus groups to elicit perceptions of LAI versus daily oral ART; discrete choice experiment (DCE) surveys to quantify preferences for different ART delivery options and related supports; and a nonrandomized trial to assess the implementation and utility of newly developed tools at 6 partnering Ryan White HIV/AIDS Program Part A MCM programs based in urban, suburban, and semirural areas of New York. Findings from the focus groups and DCEs, as well as feedback from advisory board meetings, informed the design and selection of the tools: a patient-facing, 2-page fact sheet, including frequently asked questions and a side-by-side comparison of LAI with daily oral ART; a patient-facing informational video available on YouTube (Google Inc); and a patient-provider decision aid. Implementation outcomes, measured through provider interviews, surveys, and service reporting, will guide further specification of strategies to integrate LAI ART options into MCM program workflows. RESULTS The study was funded in late April 2021 and received approval from the institutional review board in May 2021 under protocol 20-096. Focus groups were conducted in late 2021 (n=21), DCEs ran from June 2022 to January 2023 (n=378), and tools for piloting were developed by May 2023. The trial (May 2023 through January 2024) has enrolled >200 patients. CONCLUSIONS This study is designed to provide evidence regarding the acceptability, feasibility, appropriateness, and utility of a package of patient-oriented tools for comparing and deciding between LAI ART and daily oral ART options. Study strengths include formative work to guide tool development, a mixed methods approach, and the testing of tools in real-world safety-net service settings. TRIAL REGISTRATION Clinicaltrials.gov NCT05833542; https://clinicaltrials.gov/study/NCT05833542. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56892.
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Affiliation(s)
- Mary Kathryn Irvine
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, United States
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, United States
| | - Tigran Avoundjian
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Meghan Peterson
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Connor Emmert
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, United States
| | - Morgan M Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Elizabeth A Kelvin
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, United States
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, United States
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, United States
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, United States
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McCrimmon T, Collins LF, Perez-Brumer A, Bazzi AR, Shaffer VA, Kerrigan D, Alcaide ML, Philbin MM. Long-Acting Injectable Antiretrovirals for HIV Treatment: A Multi-Site Qualitative Study of Clinic-Level Barriers to Implementation in the United States. AIDS Patient Care STDS 2024; 38:61-69. [PMID: 38381949 PMCID: PMC11250840 DOI: 10.1089/apc.2023.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Long-acting injectable antiretroviral therapy (LAI ART) has the potential to address adherence obstacles associated with daily oral ART, leading to enhanced treatment uptake, adherence, and viral suppression among people living with HIV (PLWH). Yet, its potential may be limited due to ongoing disparities in availability and accessibility. We need a better understanding of the organizational context surrounding the implementation of LAI ART, and to inform its widespread rollout, we conducted 38 in-depth interviews with medical and social service providers who offer HIV care at private and hospital-based clinics across six US cities. Our findings highlight real-world implementation barriers outside of clinical trial settings. Providers described ongoing and anticipated barriers across three stages of LAI ART implementation: (1) Patient enrollment (challenges registering patients and limited insurance coverage), (2) medication delivery (insufficient personnel and resources), and (3) leadership and management (lack of interprofessional coordination and a lack of programming guidelines). Providers described how these barriers would have a disproportionate impact on under-resourced clinics, potentially exacerbating existing disparities in LAI ART access and adherence. Our findings suggest strategies that clinic leadership, policymakers, and other stakeholders can pursue to promote rapid and equitable LAI ART implementation in clinics across the United States. Resource and staffing investments could support clinics to begin, sustain, and scale up LAI ART delivery; additionally, the establishment of guidelines and tools could facilitate wider adoption of LAI ART across clinical settings. These efforts are crucial to promote resourced, standardized, and equitable implementation of LAI ART and maximize its potential to help end the HIV epidemic.
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Affiliation(s)
- Tara McCrimmon
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lauren F. Collins
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela R. Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Victoria A. Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Maria L. Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Morgan M. Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Attaianese F, Dalpiaz I, Failla M, Pasquali E, Galli L, Chiappini E. Fixed-dose antiretroviral combinations in children living with human immunodeficiency virus type 1 (HIV-1): a systematic review. J Chemother 2023:1-15. [PMID: 38153234 DOI: 10.1080/1120009x.2023.2297095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
Fixed-Dose antiretroviral Combinations (FDCs) are the most used drug regimes in adult patients with human-immunodeficiency virus 1 infection, since they increase adherence to antiretroviral therapy and enable good quality of life. The European AIDS Clinical Society guidelines recommend the use of FDCs in paediatrics. However, the use of FDCs in paediatric population is restricted since studies in children and adolescents are mostly conducted in small sample sizes and are heterogeneous in settings and design. This systematic review aims to summarize the current knowledge about the use of FDCs in paediatric population, highlighting the relevant outcomes regarding efficacy and effectiveness, adherence, safety, and adverse events of these regimens.
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Affiliation(s)
- Federica Attaianese
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Irene Dalpiaz
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Martina Failla
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Elisa Pasquali
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
- Paediatric Infectious Disease Unit, IRCCS Anna Meyer Children's Hospital, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
- Paediatric Infectious Disease Unit, IRCCS Anna Meyer Children's Hospital, Florence, Italy
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Doshi RK, Hull S, Broun A, Boyani S, Moch D, Visconti AJ, Castel AD, Baral S, Colasanti J, Rodriguez AE, Jones J, Coffey S, Monroe AK. Lessons learned from U.S. rapid antiretroviral therapy initiation programs. Int J STD AIDS 2023; 34:945-955. [PMID: 37461333 PMCID: PMC11000141 DOI: 10.1177/09564624231185622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Rapid antiretroviral therapy initiation (R-ART) for treatment of HIV has been recommended since 2017, however it has not been adopted widely across the US. PURPOSE The study purpose was to understand facilitators and barriers to R-ART implementation in the U.S. RESEARCH DESIGN This was a qualitative design involving semi-structured interviews. STUDY SAMPLE The study sample was comprised of the medical leadership of nine US HIV clinics that were early implementers of R-ART. DATA COLLECTION AND ANALYSIS In-depth, semi-structured interviews were performed. The Consolidated Framework for Implementation Research (CFIR) was used to guide thematic analysis. RESULTS We identified three main content areas: strong scientific rationale for R-ART, buy-in from multiple key stakeholders, and the condensed timeline of R-ART. The CFIR construct of Evidence Strength and Quality was cited as an important factor in R-ART implementation. Buy-in from key stakeholders and immediate access to medications ensured the success of R-ART implementation. Patient acceptance of the condensed timeline for ART initiation was facilitated when presented in a patient-centered manner, including empathetic communication and addressing other patient needs concurrently. The condensed timeline of R-ART presented logistical challenges and opportunities for the development of intense patient-provider relationships. CONCLUSIONS Results from the analysis showed that R-ART implementation should address the following: 1) logistical planning to implement HIV treatment with a condensed timeline 2) patients' mixed reactions to a new HIV diagnosis and 3) the high cost of HIV medications.
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Affiliation(s)
- Rupali K Doshi
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- The HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), District of Columbia Department of Health, Washington, DC, USA
| | - Shawnika Hull
- Rutgers University School of Communication and Information, New Brunswick, NJ, USA
| | - Aaron Broun
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Saanjh Boyani
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Darryl Moch
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Adam J Visconti
- The HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), District of Columbia Department of Health, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Joyce Jones
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susa Coffey
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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7
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Foka FET, Mufhandu HT. Current ARTs, Virologic Failure, and Implications for AIDS Management: A Systematic Review. Viruses 2023; 15:1732. [PMID: 37632074 PMCID: PMC10458198 DOI: 10.3390/v15081732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Antiretroviral therapies (ARTs) have revolutionized the management of human immunodeficiency virus (HIV) infection, significantly improved patient outcomes, and reduced the mortality rate and incidence of acquired immunodeficiency syndrome (AIDS). However, despite the remarkable efficacy of ART, virologic failure remains a challenge in the long-term management of HIV-infected individuals. Virologic failure refers to the persistent detectable viral load in patients receiving ART, indicating an incomplete suppression of HIV replication. It can occur due to various factors, including poor medication adherence, drug resistance, suboptimal drug concentrations, drug interactions, and viral factors such as the emergence of drug-resistant strains. In recent years, extensive efforts have been made to understand and address virologic failure in order to optimize treatment outcomes. Strategies to prevent and manage virologic failure include improving treatment adherence through patient education, counselling, and supportive interventions. In addition, the regular monitoring of viral load and resistance testing enables the early detection of treatment failure and facilitates timely adjustments in ART regimens. Thus, the development of novel antiretroviral agents with improved potency, tolerability, and resistance profiles offers new options for patients experiencing virologic failure. However, new treatment options would also face virologic failure if not managed appropriately. A solution to virologic failure requires a comprehensive approach that combines individualized patient care, robust monitoring, and access to a range of antiretroviral drugs.
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Affiliation(s)
- Frank Eric Tatsing Foka
- Department of Microbiology, Virology Laboratory, School of Biological Sciences, Faculty of Natural and Agricultural Sciences, North West University, Mafikeng, Private Bag, Mmabatho X2046, South Africa
| | - Hazel Tumelo Mufhandu
- Department of Microbiology, Virology Laboratory, School of Biological Sciences, Faculty of Natural and Agricultural Sciences, North West University, Mafikeng, Private Bag, Mmabatho X2046, South Africa
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Sweitzer S, Giegold M, Chen Y, Farber EW, Sumitani J, Henderson A, Easley K, Armstrong WS, Colasanti JA, Ammirati RJ, Marconi VC. The CARES Program: Improving Viral Suppression and Retention in Care Through a Comprehensive Team-Based Approach to Care for People with HIV and Complex Psychosocial Needs. AIDS Patient Care STDS 2023; 37:416-424. [PMID: 37566532 PMCID: PMC10623061 DOI: 10.1089/apc.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
Retention in HIV care and viral suppression rates remain suboptimal, especially among people with HIV (PWH) facing complex barriers to care such as mental health conditions, substance use disorders, and housing insecurity. The Center for Adherence, Retention, and Engagement Support (CARES) program utilizes an interdisciplinary team that delivers integrated services in a drop-in setting to provide individualized care to PWH with complex psychosocial needs. We describe the CARES program and evaluate its effectiveness in retaining patients in care to achieve virological suppression. We characterized 119 referrals of PWH experiencing homelessness, mental health conditions, and substance use disorders to CARES between 2011 and 2017, and collected data for a 24-month observation period through 2019. Outcomes of patients who participated in CARES were compared with those who were referred but did not participate. The primary outcome was viral suppression (<200 copies/mL) at least once during 2-year follow-up. Retention in care (≥2 completed medical visits ≥90 days apart in each year post-referral) was a secondary outcome. Of 119 PWH referred to CARES, 59 participated with ≥2 visits. Those who participated in CARES were more likely to achieve viral suppression [adjusted odds ratio (aOR) 3.50, 95% confidence interval (CI) 1.19-10.32] and to be retained in care (aOR 3.73, 95% CI 1.52-9.14) compared with those who were referred but did not participate. This analysis found that the CARES program improved retention in care and viral suppression among PWH with complex psychosocial needs and suggests that it may represent a useful model for future programming.
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Affiliation(s)
- Stephanie Sweitzer
- J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Maddie Giegold
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yunyun Chen
- Biostatistics and Informatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Eugene W. Farber
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Jeri Sumitani
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | | | - Kirk Easley
- Biostatistics and Informatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Wendy S. Armstrong
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A. Colasanti
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Rachel J. Ammirati
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Vincent C. Marconi
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Atlanta, Georgia, USA
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9
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Farooq HZ, Apea V, Kasadha B, Ullah S, Hilton-Smith G, Haley A, Scherzer J, Hand J, Paparini S, Phillips R, Orkin CM. Study protocol: the ILANA study - exploring optimal implementation strategies for long-acting antiretroviral therapy to ensure equity in clinical care and policy for women, racially minoritised people and older people living with HIV in the UK - a qualitative multiphase longitudinal study design. BMJ Open 2023; 13:e070666. [PMID: 37423623 DOI: 10.1136/bmjopen-2022-070666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION Cabotegravir and rilpivirine (CAB+RPV long-acting (LA)) is recommended as a treatment for HIV-1 allowing people living with HIV to receive 2 monthly injectable treatment, rather than daily pills. Providing injectable therapy in a system designed to provide and manage study participants on oral treatments poses logistical challenges namely how resources are used to accommodate patient preference within constrained health economies with capacity limitations. In this pragmatic multicentre study, we aim to understand the implementation of CAB-RPV-LA administration in two settings via mixed methods to explore perspectives of participants and the clinical team delivering CAB+RPV LA. METHODS AND ANALYSIS Women, racially minoritised people and older people are chronically under-represented in HIV clinical trials so the ILANA trial has set recruitment caps to ensure recruitment of 50% women, 50% ethnically diverse people and 30% over 50 years of age to include a more representative study population. Using a mixed-methods approach, the primary objective is to identify and evaluate the critical implementation strategies for CAB+RPV LA in both hospital and community settings. Secondary objectives include evaluating feasibility and acceptability of CAB+RPV LA administration at UK clinics and community settings from the perspective of HIV care providers, nurses and representatives at community sites, evaluating barriers to implementation, the utility of implementation strategies and adherence. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Health Research Authority Research Ethics Committee (REC reference: 22/PR/0318). The dissemination strategy has been formulated with the SHARE Collaborative Community Advisory Board to maximise the impact of this work on clinical care and policy. This strategy draws on and leverages existing resources within the participating organisations, such as their academic infrastructure, professional relationships and community networks. The strategy will leverage the Public Engagement Team and press office to support dissemination of findings. TRIAL REGISTRATION NUMBER NCT05294159.
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Affiliation(s)
- Hamzah Z Farooq
- Blizard Institute, Queen Mary University, London, UK
- SHARE Collaborative, Queen Mary University, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Vanessa Apea
- Blizard Institute, Queen Mary University, London, UK
- SHARE Collaborative, Queen Mary University, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Bakita Kasadha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sadna Ullah
- Blizard Institute, Queen Mary University, London, UK
- SHARE Collaborative, Queen Mary University, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | | | | | | | - James Hand
- SHARE Collaborative, Queen Mary University, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Sara Paparini
- SHARE Collaborative, Queen Mary University, London, UK
- Centre for Public Health and Policy, Wolfson Institute of Population Health, Queen Mary University, London, UK
| | - Rachel Phillips
- Pragmatic Clinical Trials Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Chloe M Orkin
- Blizard Institute, Queen Mary University, London, UK
- SHARE Collaborative, Queen Mary University, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
- Barts and The London School of Medicine and Dentistry, London, UK
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10
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Toska E, Zhou S, Chen-Charles J, Gittings L, Operario D, Cluver L. Factors Associated with Preferences for Long-Acting Injectable Antiretroviral Therapy Among Adolescents and Young People Living with HIV in South Africa. AIDS Behav 2023; 27:2163-2175. [PMID: 36622486 PMCID: PMC9827015 DOI: 10.1007/s10461-022-03949-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/10/2023]
Abstract
Long-acting injectable anti-retroviral therapy (LAART) may overcome barriers to long-term adherence and improve the survival of adolescents and young people living with HIV (AYLHIV). Research on the acceptability of LAART for this age-group is limited. We asked 953 AYLHIV about their preferred (theoretical) ART mode of delivery (pill, injectable, or other) in 2017-2018, before LAART was available or known to AYLHIV in South Africa. One in eight (12%) AYLHIV preferred LAART over single or multiple pill regimens. In multivariate analyses, six factors were associated with LAART preference: medication stock-outs (aOR = 2.56, 95% CI 1.40-4.68, p = 0.002), experiencing side-effects (aOR = 1.84, 95% CI 1.15-2.97, p = 0.012), pill-burden (aOR = 1.88, 95% CI 1.20-2.94, p = 0.006), past-year treatment changes (aOR = 1.63, 95% CI 1.06-2.51, p = 0.025), any HIV stigma (aOR = 2.22, 95% CI 1.39-3.53, p ≤ 0.001) and recent ART initiation (aOR = 2.02, 95% CI 1.09-3.74, p = 0.025). In marginal effects modelling, 66% of adolescents who experienced all factors were likely to prefer LAART, highlighting the potential high acceptability of LAART among adolescents and young people living with HIV struggling to adhere and have good HIV treatment outcomes. Adolescent boys who reported high ART pill burden were more likely to prefer LAART than their female peers in moderation analyses, suggesting that LAART may be particularly important to improve treatment outcomes among male AYLHIV as they become older. Adding LAART to existing treatment options for AYLHIV, particularly higher risk groups, would support AYLHIV to attain and sustain viral suppression-the third 95, and reduce their risk of AIDS-related mortality.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
- Department of Sociology, University of Cape Town, Cape Town, South Africa.
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
- Centre for Social Science Research, Leslie Social Sciences Building, University of Cape Town, 4.89, Rondebosch, Cape Town, 7700, South Africa.
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jenny Chen-Charles
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lesley Gittings
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Don Operario
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, UK
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11
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Zhang C, Vora LK, Tekko IA, Volpe-Zanutto F, Peng K, Paredes AJ, McCarthy HO, Donnelly RF. Development of dissolving microneedles for intradermal delivery of the long-acting antiretroviral drug bictegravir. Int J Pharm 2023; 642:123108. [PMID: 37301241 DOI: 10.1016/j.ijpharm.2023.123108] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
Oral administration and intramuscular (IM) injection are commonly recommended options for human immunodeficiency virus (HIV) treatment. However, poor patient compliance due to daily oral dosing, pain at injection sites and the demand for trained healthcare staff for injections limit the success of these administration routes, especially in low-resource settings. To overcome these limitations, for the first time, we propose novel bilayer dissolving microneedles (MNs) for the intradermal delivery of long-acting nanosuspensions of the antiretroviral (ARV) drug bictegravir (BIC) for potential HIV treatment and prevention. The BIC nanosuspensions were prepared using a wet media milling technique on a laboratory scale with a particle size of 358.99 ± 18.53 nm. The drug loading of nanosuspension-loaded MNs and BIC powder-loaded MNs were 1.87 mg/0.5 cm2 and 2.16 mg/0.5 cm2, respectively. Both dissolving MNs exhibited favorable mechanical and insertion ability in the human skin simulant Parafilm® M and excised neonatal porcine skin. Importantly, the pharmacokinetic profiles of Sprague Dawley rats demonstrated that dissolving MNs were able to intradermally deliver 31% of drug loading from nanosuspension-loaded MNs in the form of drug depots. After a single application, both coarse BIC and BIC nanosuspensions achieved sustained release, maintaining plasma concentrations above human therapeutic levels (162 ng/mL) in rats for 4 weeks. These minimally invasive and potentially self-administered MNs could improve patient compliance, providing a promising platform for the delivery of nanoformulated ARVs and resulting in prolonged drug release, particularly for patients in low-resource settings.
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Affiliation(s)
- Chunyang Zhang
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn, Road, Belfast BT9 7BL, UK
| | - Lalitkumar K Vora
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn, Road, Belfast BT9 7BL, UK
| | - Ismaiel A Tekko
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn, Road, Belfast BT9 7BL, UK
| | - Fabiana Volpe-Zanutto
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn, Road, Belfast BT9 7BL, UK
| | - Ke Peng
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn, Road, Belfast BT9 7BL, UK
| | - Alejandro J Paredes
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn, Road, Belfast BT9 7BL, UK
| | - Helen O McCarthy
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn, Road, Belfast BT9 7BL, UK
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn, Road, Belfast BT9 7BL, UK.
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12
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Slama L, Porcher R, Linard F, Chakvetadze C, Cros A, Carillon S, Gallardo L, Viard JP, Molina JM. Injectable long acting antiretroviral for HIV treatment and prevention: perspectives of potential users. BMC Infect Dis 2023; 23:98. [PMID: 36803606 PMCID: PMC9936705 DOI: 10.1186/s12879-023-08071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/09/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The use of long acting injectable (LAA) antiretroviral drugs may be an alternative option for HIV treatment and prevention. Our study focused on patient perspectives to understand which individuals, among people with HIV (PWH) and pre-exposure prophylaxis (PrEP) users, would constitute the preferential target for such treatments in terms of expectations, tolerability, adherence and quality of life. METHODS The study consisted in one self-administrated questionnaire. Data collected included lifestyle issues, medical history, perceived benefits and inconveniences of LAA. Groups were compared using Wilcoxon rank tests or Fisher's exact test. RESULTS In 2018, 100 PWH and 100 PrEP users were enrolled. Overall, 74% of PWH and 89% of PrEP users expressed interest for LAA with a significantly higher rate for PrEP users (p = 0.001). No characteristics were associated with acceptance of LAA in both groups in term of demographics, lifestyle or comorbidities. CONCLUSION PWH and PrEP users expressed a high level of interest in LAA, since a large majority seems to be in favor of this new approach. Further studies should be conducted to better characterize targeted individuals.
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Affiliation(s)
- Laurence Slama
- Department of Infectious Diseases, Hôtel Dieu Hospital, APHP, 1 Place du Parvis Notre-Dame, 75004, Paris, France. .,Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France.
| | - Raphael Porcher
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004 Paris, France ,grid.411394.a0000 0001 2191 1995Centre d’Épidémiologie Clinique, AP-HP, Hôtel-Dieu, 75004 Paris, France
| | - Françoise Linard
- grid.411394.a0000 0001 2191 1995Department of Infectious Diseases, Hôtel Dieu Hospital, APHP, 1 Place du Parvis Notre-Dame, 75004 Paris, France ,Department of Infectious Diseases, Tenon Hospital, APHP, 75020 Paris, France
| | - Catherine Chakvetadze
- Departement of Infectious Diseases, Groupe Hospitalier Sud Île de France, Melun, France
| | - Agnès Cros
- grid.411394.a0000 0001 2191 1995Department of Infectious Diseases, Hôtel Dieu Hospital, APHP, 1 Place du Parvis Notre-Dame, 75004 Paris, France ,COREVIH Île de France Sud, Créteil, France
| | | | - Lucille Gallardo
- grid.411394.a0000 0001 2191 1995Department of Infectious Diseases, Hôtel Dieu Hospital, APHP, 1 Place du Parvis Notre-Dame, 75004 Paris, France ,Mesopolhis, AMU/IEP, Aix-en-Provence, France
| | - Jean-Paul Viard
- grid.411394.a0000 0001 2191 1995Department of Infectious Diseases, Hôtel Dieu Hospital, APHP, 1 Place du Parvis Notre-Dame, 75004 Paris, France ,Paris Cité University, Paris, France
| | - Jean-Michel Molina
- grid.50550.350000 0001 2175 4109Departement of Infectious Diseases, Saint Louis and Lariboisière Hospitals, APHP, Paris, France ,grid.7429.80000000121866389INSERM U944, Paris, France
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13
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Czarnogorski M, Garris CP, Dalessandro M, D'Amico R, Nwafor T, Williams W, Merrill D, Wang Y, Stassek L, Wohlfeiler MB, Sinclair GI, Mena LA, Thedinger B, Flamm JA, Benson P, Spreen WR. Perspectives of healthcare providers on implementation of long-acting cabotegravir plus rilpivirine in US healthcare settings from a Hybrid III Implementation-effectiveness study (CUSTOMIZE). J Int AIDS Soc 2022; 25:e26003. [PMID: 36094142 PMCID: PMC9465974 DOI: 10.1002/jia2.26003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction CUSTOMIZE evaluated the implementation of long‐acting (LA) cabotegravir + rilpivirine, a novel healthcare provider–administered injectable antiretroviral therapy regimen, in diverse US healthcare settings. Findings from staff‐study participants (SSPs) through 12 months of implementation are reported. Methods CUSTOMIZE was a phase IIIb, 12‐month, single‐arm, hybrid III implementation‐effectiveness study conducted from July 2019 to October 2020 at eight US clinics of five clinic types: private practice (n = 2), federally qualified health centre (n = 2), university (n = 2), AIDS Healthcare Foundation (n = 2) and health maintenance organization (n = 1). Eligible patient participants received monthly cabotegravir + rilpivirine LA injections after a 1‐month oral lead‐in. At baseline, month 4 and month 12, SSPs (n = 3 each per clinic), including physicians, nurses or injectors, and administrators, completed quantitative surveys and semi‐structured interviews to assess implementation outcomes (acceptability, appropriateness and feasibility of intervention measures), programme sustainability and SSP perceptions of, attitudes towards, and expectations for cabotegravir + rilpivirine LA. Month 12 data collection occurred during the COVID‐19 pandemic. Results In surveys, SSPs reported high mean total scores for acceptability, appropriateness and feasibility of cabotegravir + rilpivirine LA implementation at baseline (4.43, 4.52 and 4.38 of 5, respectively) and month 12 (4.45, 4.61 and 4.46 of 5, respectively), regardless of clinic type. At month 12, SSPs were positive about the implementation sustainability (mean Program Sustainability Assessment Tool score, 5.83 out of 7). At baseline, SSPs’ top concern was patients’ ability to maintain monthly appointments (81%); at month 12, 39% had this concern. The proportion of SSPs reporting patient injection pain or soreness as a barrier was consistent at month 12 versus baseline (48% vs. 46%). Most (78%) SSPs reported optimal implementation of cabotegravir + rilpivirine LA in their clinics was achieved in 1–3 months. In interviews, SSP‐reported strategies for successful implementation included teamwork, using a web‐based treatment planner and having a designated person to track appointment scheduling. In month 12 interviews, SSP‐reported structural changes needed for implementation included changing clinic hours and purchasing refrigerators. Conclusions In CUSTOMIZE, cabotegravir + rilpivirine LA was successfully implemented across a range of US healthcare settings. Barriers were mitigated with minor process adjustments.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Leandro A Mena
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Jason A Flamm
- Kaiser Permanente Sacramento, Sacramento, California, USA
| | - Paul Benson
- Be Well Medical Center, Berkley, California, USA
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14
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A long-acting formulation of rifabutin is effective for prevention and treatment of Mycobacterium tuberculosis. Nat Commun 2022; 13:4455. [PMID: 35941109 PMCID: PMC9360445 DOI: 10.1038/s41467-022-32043-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/14/2022] [Indexed: 11/08/2022] Open
Abstract
Tuberculosis (TB) is a communicable disease caused by Mycobacterium tuberculosis (Mtb) and is a major cause of morbidity and mortality. Successful treatment requires strict adherence to drug regimens for prolonged periods of time. Long-acting (LA) delivery systems have the potential to improve adherence. Here, we show the development of LA injectable drug formulations of the anti-TB drug rifabutin made of biodegradable polymers and biocompatible solvents that solidifies after subcutaneous injection. Addition of amphiphilic compounds increases drug solubility, allowing to significantly increase formulation drug load. Solidified implants have organized microstructures that change with formulation composition. Higher drug load results in smaller pore size that alters implant erosion and allows sustained drug release. The translational relevance of these observations in BALB/c mice is demonstrated by (1) delivering high plasma drug concentrations for 16 weeks, (2) preventing acquisition of Mtb infection, and (3) clearing acute Mtb infection from the lung and other tissues.
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15
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Long-Acting Injectable Drugs for HIV-1 Pre-Exposure Prophylaxis: Considerations for Africa. Trop Med Infect Dis 2022; 7:tropicalmed7080154. [PMID: 36006246 PMCID: PMC9414191 DOI: 10.3390/tropicalmed7080154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Sub-Saharan Africa carries the highest burden of HIV-1 and AIDS. About 39% of all new infections in the world in 2020 were in this region. Oral PrEP was found to be very effective in reducing the risk of HIV-1 transmission. However, its effectiveness is highly dependent on users adhering to the drugs. The availability of long-acting injectable PrEP that eliminates the need for a daily pill may increase PrEP uptake and adherence in people who struggle to adhere to oral PrEP. The USA’s FDA approved long-acting cabotegravir (CAB-LA) for PrEP of HIV-1 in December 2021. In this review, we discussed the implementation challenges to the successful roll-out of CAB-LA in Africa and measures to address these implementation challenges. Some health system-level challenges include the cost of the drug, its refrigeration requirement, and the shortage of healthcare providers trained to administer parenteral medicines. In contrast, client challenges include lack of knowledge, accessibility of the drug, side effects, stigma, and lack of family and community support. These challenges can be addressed by several measures emanating from lessons learned from the successful implementation of ART, oral PrEP, and immunization in the continent. Some steps include advocating for waiving of CAB-LA patent licence, conducting demonstration projects in Africa, promoting the use of renewable energy sources such as solar energy, healthcare provider training, task shifting, community engagement, client education, and implementing adherence promotion strategies.
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16
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Deodhar S, Sillman B, Bade AN, Avedissian SN, Podany AT, McMillan JM, Gautam N, Hanson B, Dyavar Shetty BL, Szlachetka A, Johnston M, Thurman M, Munt DJ, Dash AK, Markovic M, Dahan A, Alnouti Y, Yazdi A, Kevadiya BD, Byrareddy SN, Cohen SM, Edagwa B, Gendelman HE. Transformation of dolutegravir into an ultra-long-acting parenteral prodrug formulation. Nat Commun 2022; 13:3226. [PMID: 35680875 PMCID: PMC9184486 DOI: 10.1038/s41467-022-30902-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/20/2022] [Indexed: 11/09/2022] Open
Abstract
Ultra-long-acting integrase strand transfer inhibitors were created by screening a library of monomeric and dimeric dolutegravir (DTG) prodrug nanoformulations. This led to an 18-carbon chain modified ester prodrug nanocrystal (coined NM2DTG) with the potential to sustain yearly dosing. Here, we show that the physiochemical and pharmacokinetic (PK) formulation properties facilitate slow drug release from tissue macrophage depot stores at the muscle injection site and adjacent lymphoid tissues following single parenteral injection. Significant plasma drug levels are recorded up to a year following injection. Tissue sites for prodrug hydrolysis are dependent on nanocrystal dissolution and prodrug release, drug-depot volume, perfusion, and cell-tissue pH. Each affect an extended NM2DTG apparent half-life recorded by PK parameters. The NM2DTG product can impact therapeutic adherence, tolerability, and access of a widely used integrase inhibitor in both resource limited and rich settings to reduce HIV-1 transmission and achieve optimal treatment outcomes.
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Affiliation(s)
- Suyash Deodhar
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Brady Sillman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA.,Nebraska Nanomedicine Production Plant, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Aditya N Bade
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Sean N Avedissian
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Anthony T Podany
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - JoEllyn M McMillan
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Nagsen Gautam
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Brandon Hanson
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Bhagya L Dyavar Shetty
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Adam Szlachetka
- Nebraska Nanomedicine Production Plant, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Morgan Johnston
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Michellie Thurman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Daniel J Munt
- Department of Pharmacy Sciences, Creighton University, Omaha, NE, 68178, USA
| | - Alekha K Dash
- Department of Pharmacy Sciences, Creighton University, Omaha, NE, 68178, USA
| | - Milica Markovic
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Arik Dahan
- Department of Clinical Pharmacology, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel
| | - Yazen Alnouti
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Alborz Yazdi
- Exavir Therapeutics, Inc., New York, NY, 10012, USA
| | - Bhavesh D Kevadiya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Samuel M Cohen
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Benson Edagwa
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA. .,Nebraska Nanomedicine Production Plant, University of Nebraska Medical Center, Omaha, NE, 68198, USA. .,Exavir Therapeutics, Inc., New York, NY, 10012, USA.
| | - Howard E Gendelman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198, USA. .,Nebraska Nanomedicine Production Plant, University of Nebraska Medical Center, Omaha, NE, 68198, USA. .,Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, 68198, USA. .,Exavir Therapeutics, Inc., New York, NY, 10012, USA.
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17
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Prodrug Therapies for Infectious and Neurodegenerative Diseases. Pharmaceutics 2022; 14:pharmaceutics14030518. [PMID: 35335894 PMCID: PMC8953076 DOI: 10.3390/pharmaceutics14030518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 02/06/2023] Open
Abstract
Prodrugs are bioreversible drug derivatives which are metabolized into a pharmacologically active drug following chemical or enzymatic modification. This approach is designed to overcome several obstacles that are faced by the parent drug in physiological conditions that include rapid drug metabolism, poor solubility, permeability, and suboptimal pharmacokinetic and pharmacodynamic profiles. These suboptimal physicochemical features can lead to rapid drug elimination, systemic toxicities, and limited drug-targeting to disease-affected tissue. Improving upon these properties can be accomplished by a prodrug design that includes the careful choosing of the promoiety, the linker, the prodrug synthesis, and targeting decorations. We now provide an overview of recent developments and applications of prodrugs for treating neurodegenerative, inflammatory, and infectious diseases. Disease interplay reflects that microbial infections and consequent inflammation affects neurodegenerative diseases and vice versa, independent of aging. Given the high prevalence, personal, social, and economic burden of both infectious and neurodegenerative disorders, therapeutic improvements are immediately needed. Prodrugs are an important, and might be said a critical tool, in providing an avenue for effective drug therapy.
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18
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Chandiwana NC, Serenata CM, Owen A, Rannard S, Pérez Casas C, Scott C, Hill A, Clayden P, Flexner C. Impact of long-acting therapies on the global HIV epidemic. AIDS 2021; 35:S137-S143. [PMID: 34848580 DOI: 10.1097/qad.0000000000003102] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Long-acting antiretroviral drugs have emerged as exciting treatment and preexposure prophylaxis (PrEP) options for people with HIV and at risk of HIV. Long-acting regimens may improve dosing convenience, tolerability and cost compared with current daily-based oral therapy. They can also circumvent stigma associated with oral therapy for both treatment and PrEP, thereby improving adherence and outcomes. Yet, multiple challenges remain, many specific to low-income and middle-income countries (LMICs), where the epidemic is most concentrated and HIV prevention and treatment options are limited. To optimize the use of long-acting formulations, key outstanding questions must be addressed. Uncertain costing, scale-up manufacturing, complex delivery systems and implementation challenges are potential barriers when considering the scalability of long-acting ARVs for global use.
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Affiliation(s)
- Nomathemba C Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celicia M Serenata
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology
| | - Steve Rannard
- Department of Chemistry, Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool, United Kingdom
| | | | | | - Andrew Hill
- Department of Translational Medicine, Liverpool University, Liverpool
| | | | - Charles Flexner
- Divisions of Clinical Pharmacology and Infectious Diseases, School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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19
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Predicting Drug-Drug Interactions between Rifampicin and Ritonavir-Boosted Atazanavir Using PBPK Modelling. Clin Pharmacokinet 2021; 61:375-386. [PMID: 34635995 PMCID: PMC9481493 DOI: 10.1007/s40262-021-01067-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 01/12/2023]
Abstract
Objectives The aim of this study was to simulate the drug–drug interaction (DDI) between ritonavir-boosted atazanavir (ATV/r) and rifampicin (RIF) using physiologically based pharmacokinetic (PBPK) modelling, and to predict suitable dose adjustments for ATV/r for the treatment of people living with HIV (PLWH) co-infected with tuberculosis. Methods A whole-body DDI PBPK model was designed using Simbiology 9.6.0 (MATLAB R2019a) and verified against reported clinical data for all drugs administered alone and concomitantly. The model contained the induction mechanisms of RIF and ritonavir (RTV), the inhibition effect of RTV for the enzymes involved in the DDI, and the induction and inhibition mechanisms of RIF and RTV on the uptake and efflux hepatic transporters. The model was considered verified if the observed versus predicted pharmacokinetic values were within twofold. Alternative ATV/r dosing regimens were simulated to achieve the trough concentration (Ctrough) clinical cut-off of 150 ng/mL. Results The PBPK model was successfully verified according to the criteria. Simulation of different dose adjustments predicted that a change in regimen to twice-daily ATV/r (300/100 or 300/200 mg) may alleviate the induction effect of RIF on ATV Ctrough, with > 95% of individuals predicted to achieve Ctrough above the clinical cut-off. Conclusions The developed PBPK model characterized the induction-mediated DDI between RIF and ATV/r, accurately predicting the reduction of ATV plasma concentrations in line with observed clinical data. A change in the ATV/r dosing regimen from once-daily to twice-daily was predicted to mitigate the effect of the DDI on the Ctrough of ATV, maintaining plasma concentration levels above the therapeutic threshold for most patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40262-021-01067-1.
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20
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Simoni JM, Beima-Sofie K, Wanje G, Mohamed ZH, Tapia K, McClelland RS, Ho RJY, Collier AC, Graham SM. "Lighten This Burden of Ours": Acceptability and Preferences Regarding Injectable Antiretroviral Treatment Among Adults and Youth Living With HIV in Coastal Kenya. J Int Assoc Provid AIDS Care 2021; 20:23259582211000517. [PMID: 33685272 PMCID: PMC7952847 DOI: 10.1177/23259582211000517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Long-acting injectable (LAI) antiretroviral therapy (ART) may offer persons living with HIV (PLWH) an attractive alternative to pill-based treatment options, yet acceptability data remain scant, especially in sub-Saharan Africa. Methods: We conducted 6 focus group discussions with PLWH, including key stake holder groups, and analyzed data with content analysis. Results: Initial reactions to the idea of LAI-ART were often positive. The primary advantages voiced were potential to facilitate improved adherence and alleviate the burden of daily pill-taking while avoiding inadvertent disclosure and HIV stigma. Potential side effects were a particular concern of the women. Most participants preferred clinic-based administration over self-injections at home due to concerns about safety, privacy, and potential need for refrigeration. Conclusions: LAI-ART may be acceptable in Kenya, provided injections are infrequent and delivered in a clinic setting. However, HIV stigma, fear of potential side effects, and limited clinical capacity would need to be addressed.
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Affiliation(s)
- Jane M Simoni
- Department of Psychology, 7284University of Washington, Seattle Washington, USA.,Department of Global Health, 7284University of Washington, Seattle Washington, USA.,Department of Gender, Women and Sexuality Studies, 7284University of Washington, Seattle Washington, USA
| | - Kristin Beima-Sofie
- Department of Global Health, 7284University of Washington, Seattle Washington, USA
| | - George Wanje
- Department of Medical Microbiology, 107854University of Nairobi, Nairobi, Kenya
| | - Zahra H Mohamed
- Department of Global Health, 7284University of Washington, Seattle Washington, USA
| | - Kenneth Tapia
- Department of Global Health, 7284University of Washington, Seattle Washington, USA
| | - R Scott McClelland
- Department of Global Health, 7284University of Washington, Seattle Washington, USA.,Department of Medical Microbiology, 107854University of Nairobi, Nairobi, Kenya.,Department of Medicine, 7284University of Washington, Seattle Washington, USA.,Department of Epidemiology, 7284University of Washington, Seattle Washington, USA
| | - Rodney J Y Ho
- Department of Pharmaceutics, 7284University of Washington, Seattle Washington, USA.,Department of Bioengineering, 7284University of Washington, Seattle Washington, USA
| | - Ann C Collier
- Department of Medicine, 7284University of Washington, Seattle Washington, USA
| | - Susan M Graham
- Department of Global Health, 7284University of Washington, Seattle Washington, USA.,Department of Medicine, 7284University of Washington, Seattle Washington, USA.,Department of Epidemiology, 7284University of Washington, Seattle Washington, USA
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21
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Koren DE, Fedkiv V, Zhao H, Kludjian G, Bettiker RL, Tedaldi E, Samuel R. Perceptions of Long-Acting Injectable Antiretroviral Treatment Regimens in a United States Urban Academic Medical Center. J Int Assoc Provid AIDS Care 2021; 19:2325958220981265. [PMID: 33327851 PMCID: PMC7750752 DOI: 10.1177/2325958220981265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patient acceptance of long-acting injectable antiretroviral (LAI-ARV) HIV-1
regimens will determine uptake. Although previous literature reports high
satisfaction, these data stem from clinical trials subject to selection bias.
This cross-sectional survey from the HIV practices of an urban academic medical
center assessed perceptions and preferences using Likert scales toward overall
acceptability, proposed frequencies, injection-site reaction durations, and
distribution venue. 59% of surveys were completed resulting 202 respondents. 60%
were male, 72% black, and the median age was 49 (IQR 36-58). 93% reported a once
daily tablet frequency, 69% reported single tablet regimens, and 59% reported
missing zero doses in the prior 30 days. Patients self-categorized as likely
(57%) or unlikely (43%) to accept LAI-ARV. Both decreasing frequencies between
injections and durations of injection-site reactions resulted higher
acceptability scores. 57% of respondents preferred receiving an injectable from
their clinician’s office over other potential options. These data demonstrate
positive LAI-ARV acceptance potential.
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Affiliation(s)
- David E Koren
- Department of Pharmacy Services, Temple University Hospital, Philadelphia, PA, USA
| | - Volodymyra Fedkiv
- Department of Pharmacy Services, Temple University Hospital, Philadelphia, PA, USA
| | - Huaqing Zhao
- Department of Clinical Sciences, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Geena Kludjian
- Department of Pharmacy Services, Temple University Hospital, Philadelphia, PA, USA
| | - Robert L Bettiker
- Section of Infectious Diseases, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ellen Tedaldi
- Section of General Internal Medicine, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Rafik Samuel
- Section of Infectious Diseases, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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22
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Morton T, Chege W, Swann E, Senn TE, Cleland N, Renzullo PO, Stirratt MJ. Advancing long-acting and extended delivery HIV prevention and treatment regimens through behavioural science: NIH workshop directions. AIDS 2021; 35:1313-1317. [PMID: 33710013 DOI: 10.1097/qad.0000000000002863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tia Morton
- Division of AIDS, National Institute of Allergy and Infectious Disease (NIAID)
| | - Wairimu Chege
- Division of AIDS, National Institute of Allergy and Infectious Disease (NIAID)
| | - Edith Swann
- Division of AIDS, National Institute of Allergy and Infectious Disease (NIAID)
| | - Theresa E Senn
- Division of AIDS Research, National Institute of Mental Health (NIMH), Bethesda, Maryland, USA
| | - Naana Cleland
- Division of AIDS, National Institute of Allergy and Infectious Disease (NIAID)
| | - Philip O Renzullo
- Division of AIDS, National Institute of Allergy and Infectious Disease (NIAID)
| | - Michael J Stirratt
- Division of AIDS Research, National Institute of Mental Health (NIMH), Bethesda, Maryland, USA
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23
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Dawood H. The optimum implementation of long-acting injectable cabotegravir-rilpivirine in sub-Saharan Africa. LANCET GLOBAL HEALTH 2021; 9:e563-e564. [PMID: 33770512 DOI: 10.1016/s2214-109x(21)00052-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Halima Dawood
- Infectious Diseases Unit, Department of Internal Medicine, Greys Hospital, Pietermaritzburg 3201, South Africa.
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24
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Mantsios A, Murray M, Karver TS, Davis W, Galai N, Kumar P, Swindells S, Bredeek UF, García RR, Antela A, Gomis SC, Bernáldez MP, Czarnogorski M, Hudson K, Walters N, Kerrigan D. Multi-level considerations for optimal implementation of long-acting injectable antiretroviral therapy to treat people living with HIV: perspectives of health care providers participating in phase 3 trials. BMC Health Serv Res 2021; 21:255. [PMID: 33743684 PMCID: PMC7980753 DOI: 10.1186/s12913-021-06214-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background Long-acting injectable antiretroviral therapy (LA ART) has been shown to be non-inferior to daily oral ART, with high patient satisfaction and preference to oral standard of care in research to date, and has recently been approved for use in the United States and Europe. This study examined the perspectives of health care providers participating in LA ART clinical trials on potential barriers and solutions to LA ART roll-out into real world settings. Methods This analysis draws on two data sources: (1) open-ended questions embedded in a structured online survey of 329 health care providers participating in the ATLAS-2 M trial across 13 countries; and (2) in-depth interviews with 14 providers participating in FLAIR/ ATLAS/ATLAS-2 M trials in the United States and Spain. Both assessments explored provider views and clinic dynamics related to the introduction of LA ART and were analyzed using thematic content analysis. The Consolidated Framework for Implementation Research (CFIR) was drawn on as the conceptual framework underpinning development of a model depicting study findings. Results Barriers and proposed solutions to LA ART implementation were identified at the individual, clinic and health system levels. Provider perceptions of patient level barriers included challenges with adhering to frequent injection appointments and injection tolerability. Proposed solutions included patient education, having designated staff for clinic visit retention, and clinic flexibility with appointment scheduling. The main provider concern was identifying appropriate candidates for LA ART; proposed solutions focused on patient provider communication and decision making. Clinic level barriers included the need for additional skilled individuals to administer injections, shifts in workflow as demand increases and the logistics of cold-chain storage. Proposed solutions included staff hiring and training, strategic planning around workflow and logistics, and the possibility of offering injections in other settings, including the home. Health system level barriers included cost and approvals from national regulatory bodies. Potential solutions included governments subsidizing treatment, ensuring cost is competitive with oral ART, and offering co-pay assistance. Conclusions Results suggest the importance of multi-level support systems to optimize patient-provider communication and treatment decision-making; clinic staffing, workflow, logistics protocols and infrastructure; and cost-related factors within a given health system. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06214-9.
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Affiliation(s)
| | | | | | - Wendy Davis
- George Washington University, Washington, DC, USA
| | - Noya Galai
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Antonio Antela
- Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Kerrigan D, Murray M, Sanchez Karver T, Mantsios A, Walters N, Hudson K, Kaplan-Lewis E, Pulido F, Bassa AC, Margolis D, Galai N. Feasibility of Implementing Long-Acting Injectable Antiretroviral Therapy to Treat HIV: A Survey of Health Providers from the 13 Countries Participating in the ATLAS-2M Trial. AIDS Res Hum Retroviruses 2021; 37:207-213. [PMID: 33323029 DOI: 10.1089/aid.2020.0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Long-acting (LA) injectable antiretroviral therapy (ART) was found noninferior to daily oral ART in Phase 3 trials with high patient satisfaction. Limited information on provider experiences with LA ART exists, which is critical to inform real-world implementation. An online survey of health providers from the 13 countries participating in the Phase 3b ATLAS-2M trial was conducted. A total of 293 providers responded to questions on LA ART feasibility. Multivariable regression was utilized to identify factors related to the feasibility of LA ART every month and every 2 months within routine care such as the characteristics, experiences, and attitudes of providers, and perceptions of patient benefits and barriers. A majority of providers indicated that it would be very feasible (62.8%) or somewhat feasible (32.1%) to administer monthly LA ART. Feasibility scores were higher for delivering LA ART every 2 months versus monthly (mean 28.3 vs. 26.9; p value <.001). African providers had higher odds of perceived overall feasibility of monthly LA ART [adjusted odds ratio (aOR) 2.9, 95% confidence interval (CI) 1.9-4.4] versus those from other regions, as did providers reporting a greater number of benefits for patients (aOR 1.1, 95% CI 1.0-1.1) versus those reporting less. Providers reporting a greater number of patient barriers to adhere to clinic appointments had lower odds of perceived feasibility of monthly LA ART (aOR 0.8, 95% CI 0.7-1.0) versus those reporting less. Findings highlight the need for further implementation research regarding barriers, facilitators, and strategies to optimize the introduction of LA ART outside of clinical trials.
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Affiliation(s)
- Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | | | - Tahilin Sanchez Karver
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea Mantsios
- Public Health Innovation and Action, New York, New York, USA
| | | | | | - Emma Kaplan-Lewis
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Federico Pulido
- HIV Unit, Hospital 12 de Octubre, imas12, UCM, Madrid, Spain
| | | | | | - Noya Galai
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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26
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Akinwunmi B, Buchenberger D, Scherzer J, Bode M, Rizzini P, Vecchio F, Roustand L, Nachbaur G, Finkielsztejn L, Chounta V, Van de Velde N. Factors associated with interest in a long-acting HIV regimen: perspectives of people living with HIV and healthcare providers in four European countries. Sex Transm Infect 2021; 97:566-573. [PMID: 33632889 DOI: 10.1136/sextrans-2020-054648] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES A novel long-acting regimen (LAR) of cabotegravir and rilpivirine for HIV treatment requires dosing every 2 months instead of daily. We assessed what proportion of people living with HIV and physicians would be interested in trying and offering LAR respectively and why. METHODS 688 people living with HIV on treatment, and 120 HIV physicians completed web-based surveys in Germany, Italy, the UK and France during 2019. Balanced description of a hypothetical LAR regarding efficacy, administration and possible side effects were provided. The hypothetical long-acting injections were assumed to be cost-neutral to current daily oral antiretrovirals. Interest of people living with HIV in trying ('very'/'highly') and physicians' willingness to offer ('definitely'/'probably') this LAR in different situations, with perceived benefits/concerns was measured. RESULTS Of people living with HIV, 65.8% were interested in trying LAR. The majority (~80%-90%) of those with unmet needs felt LAR would help, including those with strong medical needs (malabsorption and interfering gastrointestinal conditions), suboptimal adherence, confidentiality/privacy concerns and emotional burden of daily dosing. Of physicians, percentage willing to offer LAR varied situationally: strong medical need (dysphagia, 93.3%; malabsorption, 91.6%; interfering gastrointestinal issues, 90.0%; central nervous system disorders, 87.5%); suboptimal adherence (84.2%); confidentiality/privacy concerns (hiding medications, 86.6%) and convenience/lifestyle (84.2%). People living with HIV liked LAR for not having to carry pills when travelling (56.3%); physicians liked the increased patient contact (54.2%). Furthermore, 50.0% of people living with HIV perceived LAR would minimise transmission risk and improve their sexual health. The most disliked attribute was scheduling appointments (37.2%) and resource constraints (57.5%) for people living with HIV and physicians, respectively. Physicians estimated 25.7% of their patients would actually switch. CONCLUSION Providers and people living with HIV viewed the described LAR as addressing several unmet needs. Alternative treatment routes and especially LAR may improve adherence and quality of life.
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27
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Kanazawa JT, Saberi P, Sauceda JA, Dubé K. The LAIs Are Coming! Implementation Science Considerations for Long-Acting Injectable Antiretroviral Therapy in the United States: A Scoping Review. AIDS Res Hum Retroviruses 2021; 37:75-88. [PMID: 33176429 PMCID: PMC8020525 DOI: 10.1089/aid.2020.0126] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Long-acting injectable antiretroviral therapy (LAI-ART) is one of the latest advancements in HIV control with the potential to overcome oral ART barriers to adherence. The objective of this article is to anticipate and examine implementation considerations for LAI-ART using components of the PRISM model, a Practical, Robust Implementation and Sustainability Model for integrating research findings into practice. We conducted a scoping review from January to August 2020 of the growing literature on LAI-ART implementation and other fields using LAI therapies. Key considerations regarding LAI-ART were parsed from the searches and entered into the PRISM implementation science framework. The PRISM framework posed multiple questions for consideration in the development of an optimal implementation strategy for LAI-ART in the United States. These questions revealed the necessity for more data, including acceptability of LAI-ART among many different subgroups of people living with HIV (PLWH), cost effectiveness, patient satisfaction, and patient-reported outcomes, as well as more detailed information related to the external environment for optimal LAI-ART implementation. Ethical considerations of LAI-ART will also need to be considered. The anticipation of, and excitement for, LAI-ART represent the hope for a new direction for HIV treatment that reduces adherence barriers and improves prognoses for PLWH. We have a unique window of opportunity to anticipate implementation considerations for LAI-ART, so this new therapy can be used to its fullest potential. Outstanding questions remain, however, that need to be addressed to help achieve HIV suppression goals in diverse populations.
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Affiliation(s)
- John T. Kanazawa
- Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Parya Saberi
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina, USA
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Culhane J, Sharma M, Wilson K, Roberts D, Mugo C, Wamalwa D, Inwani I, Barnabas RV, Kohler PK. Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya. EClinicalMedicine 2020; 25:100453. [PMID: 32954235 PMCID: PMC7486332 DOI: 10.1016/j.eclinm.2020.100453] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite high efficacy of oral antiretroviral therapy (ART), viral suppression among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA) remains low. Compared to daily oral ART, bimonthly long-acting injectable ART (LA-ART) may simplify adherence, improve clinical outcomes, and decrease HIV transmission in this priority population. However, LA-ART will likely cost more than oral ART and the cost threshold at which LA-ART will be cost effective in SSA has not been evaluated. METHODS We adapted a mathematical model of HIV transmission and progression in Kenya to include HIV acquisition and viral suppression among AYA (age 10-24). We projected the population-level health and economic impact of providing LA-ART to AYA over a 10-year time horizon assuming oral ART costs of US$233 annually and a two-month duration of viral suppression per LA-ART injection. We calculated the maximum cost at which switching from oral to LA-ART would be considered cost-effective, using thresholds of $500 and $1,508 per disability-adjusted life year averted (WHO's threshold of HIV treatment interventions and Kenya's gross domestic product per capita). FINDINGS Assuming 85% of AYA switch from oral to injectable formulations, LA-ART is estimated to prevent 40,540 infections and 20,480 deaths over 10 years. The maximum increase in the annual per-person cost of receiving LA-ART is estimated to be $89 and $236 for LA-ART to be cost-effective under the thresholds of $500 and $1,508 per DALY averted, respectively. The cost threshold was lower when non-adherent oral ART AYA users were assumed to be less likely to switch to LA-ART. INTERPRETATION Providing LA-ART to AYA can be cost-effective in Kenya if it is less than twice the cost of oral ART. Long-acting injectable ART for priority populations with low viral suppression has the potential to cost-effectively avert disability and death. FUNDING National Institutes of Health (R01 HD085807; PI: Kohler).
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Affiliation(s)
- Jessica Culhane
- Department of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United States
| | - Monisha Sharma
- Department of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United States
| | - Kate Wilson
- Department of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United States
| | - D.Allen Roberts
- Department of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United States
| | | | | | | | - Ruanne V. Barnabas
- Department of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United States
| | - Pamela K. Kohler
- Department of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United States
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Kerrigan D, Sanchez Karver T, Muraleetharan O, Savage V, Mbwambo J, Donastorg Y, Likindikoki S, Perez M, Gomez H, Mantsios A, Murray M, Beckham SW, Davis W, Galai N, Barrington C. "A dream come true": Perspectives on long-acting injectable antiretroviral therapy among female sex workers living with HIV from the Dominican Republic and Tanzania. PLoS One 2020; 15:e0234666. [PMID: 32530939 PMCID: PMC7292359 DOI: 10.1371/journal.pone.0234666] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Long-acting injectable antiretroviral therapy (LA ART) was found to be non-inferior to daily oral ART in Phase 3 clinical trials. LA ART may offer an important alternative for people living with HIV with challenges adhering to daily oral ART or preferences for non-pill-based regimens. METHODS Using a mixed methods approach integrating survey, in-depth interview and biological data from female sex workers (FSW) living with HIV in Tanzania (N = 208) and the Dominican Republic (DR) (N = 201), we assessed factors associated with the potential likelihood of LA ART use if it were available. We conducted multivariate logistic regression and thematic content analysis. RESULTS Likelihood of LA ART use was high with 84.92% of FSW from the DR and 92.27% of FSW from Tanzania reporting they would be "likely" or "very likely" to use LA ART if available (p = 0.02). In Tanzania better HIV-related patient-provider communication (AOR 4.58; 95% CI 1.90-11.05) and quality of HIV clinical care (AOR 3.68; 95% CI 1.05-12.86) were positively associated with the high likelihood of LA ART use. In the DR, easier clinic access was associated with a higher likelihood of LA ART use (AOR 3.04; 95% CI 1.41-6.56), as was greater monthly income from sex work (AOR 2.37; 95% CI 1.27-4.41). In both settings, years on ART was significantly associated with a strong likelihood of LA ART use (TZ: AOR 1.16 per year; 95% CI 1.00-1.34/DR: AOR 1.07 per year; 95% CI 1.00-1.14). Qualitative findings underscored enthusiasm for LA ART and reinforced its potential to address sex work-specific barriers to daily oral ART adherence including work-related schedules and substance use. CONCLUSIONS We found a high likelihood of LA ART use if available among FSW in two diverse settings and documented barriers to future uptake. Community-driven approaches which include tailored health education and improved patient-provider communication and quality of care, as well as strategies to facilitate appointment adherence are needed to optimize LA ART use among FSW.
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Affiliation(s)
- Deanna Kerrigan
- Department of Sociology, American University, Washington, DC, United States of America
| | - Tahilin Sanchez Karver
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ohvia Muraleetharan
- Department of Health Policy, Yale University, New Haven, Connecticut, United States of America
| | - Virginia Savage
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Andrea Mantsios
- Public Health Innovation and Action, New York, New York, United States of America
| | | | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wendy Davis
- Department of Sociology, American University, Washington, DC, United States of America
| | - Noya Galai
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
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30
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Using Implementation Science to Better Integrate Novel Long-Acting Injectable Therapy Into Routine HIV Care. J Acquir Immune Defic Syndr 2020; 82 Suppl 3:S286-S288. [PMID: 31764265 DOI: 10.1097/qai.0000000000002218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The key to maximizing the value of implementation science data is to get the learnings early. A critical contributor to early clinical research data is the biopharmaceutical industry. In partnership with the implementation research community, industry has an opportunity to play a major role to increase the value of implementation research data through earlier integration of implementation questions in the development continuum. METHODS This article suggests that by using more hybrid implementation-effectiveness study designs in phase III trials, researchers can accelerate the availability of implementation data closer to the initial introduction of novel treatments into community settings. The biopharmaceutical industry is uniquely poised to lead or collaborate on these trials. RESULTS The first LAI HIV medications are being studied for both HIV prevention and treatment. This paradigm shift in the provision of HIV care is an opportunity to blend implementation research into clinical trials earlier so that the public health community is armed with tested implementation strategies to maximize access and impact when these new medications become available. CUSTOMIZE, a novel phase IIIB-hybrid III implementation-effectiveness trial-is the first-of-its-kind study to examine different implementation strategies to overcome challenges of delivering a LAI antiretroviral medication in various types of HIV clinical settings the US health care system. CONCLUSIONS Industry can play a complimentary and additive role by partnering with implementation science researchers to understand the implementation strategies sooner in the development pipeline. These collaborations may allow for earlier, more informed, and strategic HIV public health programs in the future.
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Simoni JM, Beima-Sofie K, Mohamed ZH, Christodoulou J, Tapia K, Graham SM, Ho R, Collier AC. Long-Acting Injectable Antiretroviral Treatment Acceptability and Preferences: A Qualitative Study Among US Providers, Adults Living with HIV, and Parents of Youth Living with HIV. AIDS Patient Care STDS 2019; 33:104-111. [PMID: 30844308 DOI: 10.1089/apc.2018.0198] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To better understand acceptability of long-acting injectable antiretroviral treatment (LAI-ART) regimens for HIV management, we conducted seven semi-structured focus group discussions with experienced HIV care providers and persons living with HIV (PLWH) and five individual interviews with parents of children living with HIV in the western United States. Although providers were wary about a potential negative impact on consistent engagement in care, they predicted that patients, especially those with adherence challenges, would be enthusiastic about LAI options. Many PLWH, especially young adults, welcomed the option of an LAI-ART regimen; however, others feared injections and expressed concerns about possible side effects, dosing more frequent than every 2 weeks, additional costs, and lower efficacy. Parents' interest varied according to their child's age and sensitivity to injections. In summary, potential users considered LAI-ART generally acceptable yet voiced possible concerns as well, especially if their current pill-based regimen was effective in achieving viral suppression.
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Affiliation(s)
- Jane M. Simoni
- Department of Psychology, Women and Sexuality Studies, University of Washington, Seattle, Washington
- Department of Global Health, Women and Sexuality Studies, University of Washington, Seattle, Washington
- Department of Gender, Women and Sexuality Studies, University of Washington, Seattle, Washington
| | - Kristin Beima-Sofie
- Department of Global Health, Women and Sexuality Studies, University of Washington, Seattle, Washington
| | - Zahra H. Mohamed
- Department of Global Health, Women and Sexuality Studies, University of Washington, Seattle, Washington
| | - Joan Christodoulou
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Kenneth Tapia
- Department of Global Health, Women and Sexuality Studies, University of Washington, Seattle, Washington
| | - Susan M. Graham
- Department of Global Health, Women and Sexuality Studies, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Rodney Ho
- Department of Pharmaceutics, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Ann C. Collier
- Department of Medicine, University of Washington, Seattle, Washington
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Derrick CB, Ostermann J, Weissman SB, Hobbie A, Alshareef N, Weinhold A, Yelverton V, Thielman NM. Who Wants to Switch? Gauging Patient Interest in Novel Antiretroviral Therapies. Open Forum Infect Dis 2018; 5:ofy247. [PMID: 30364593 PMCID: PMC6197380 DOI: 10.1093/ofid/ofy247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/21/2018] [Indexed: 11/13/2022] Open
Abstract
Study participants were asked about their interest in switching to novel drug delivery systems that reduce the dosing frequency of antiretroviral regimens. Across a diverse, treatment-experienced cohort, we describe greatest interest in switching to an oral regimen taken once weekly, followed by injections taken every other month and twice-annual implants.
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Affiliation(s)
- Caroline B Derrick
- Department of Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Sharon B Weissman
- Department of Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Amy Hobbie
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Noor Alshareef
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Andrew Weinhold
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Valerie Yelverton
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Fachbereich Gesundheit, Pflege, Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
| | - Nathan M Thielman
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina.,Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
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